This headline ran over a Wall Street Journal article about rationing of health care in Canada.  It offers a sad outlook if the US Health Care System follows the Canadian “Too Old for Hip Surgery” model.  Preventive care will be the focus of the future.  Quality of Life depends on having a supportive and conscientious environment within which to age.  Recognizing the risks in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and patient level disparities.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill. 
These Doctors argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to change their own biases and actions.  The Baby Boomers are moving to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  The Rosenrkanz law firm may be able to help build a supportive care environment that does not financially exhaust the family.